SB 20, KHA’s priority legislation, passed the House yesterday by a unanimous vote. The legislation gives Kentucky’s medical providers a pathway to external, independent appeals of denied Medicaid managed-care claims. The bill is now on its way to Governor Matt Bevin for his signature. Please, take a moment to contact your legislator personally and thank him or her for their support. 

SB 20, sponsored by Senator Ralph Alvarado (R-Winchester) would allow medical providers to receive an independent third-party review of claims denied by Medicaid managed care organizations (MCOs). The decision of the third-party reviewer could then be appealed to the Cabinet for Health and Family Services, where the decision of an administrative hearing tribunal would be the last step before judicial review. This includes situations when a provider has continued to render care after a denial because, in their medical judgment, continued care was in the patient’s best interest. The process is needed to assure patients get...

KHA's priority legislation, SB 20, addresses the need for a Medicaid managed care organization (MCO) appeals process. Nina Eisner, CEO of Ridge Behavioral Health System in Lexington, testified before the Senate Health and Welfare Committee on January 13 and gave examples of why this legislation is desperately needed.